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Objective@#To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI)and contrast-enhanced ultrasound(CEUS), and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard.@*Methods@#A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited, including 61 males and 31 females, aged(63.5 ± 7.7)years(range, 42-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms, patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque(including surface morphology and neo-vascularization)were recorded.The ultrasonographic findings were chi-squarely tested.@*Results@#There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(χ2=6.865, P=0.032; χ2=22.494, P<0.001). The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups(χ2=10.367, P=0.006; χ2=8.186, P=0.041). The correlations of plaque surface morphology(r=0.856, P<0.001)and diagnostic consistency(r=0.802, P<0.001)between SMI and CEUS were higher.In the symptom group, SMI-showed plaque fissures and small surface pitting were in 33.9%(20/59)of patients, and CEUS-showed plaque fissures and small surface pitting were in 25.4%(15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard, CEUS showed a sensitivity of 42.4% and specificity of 80.4% for detecting symptomatic plaques, and SMI showed a sensitivity of 54.2% and specificity of 76.1%.The two methods had similar specificity, and SMI had a slightly higher sensitivity than did CEUS.CEUS and SMI had a good correlation of plaque neo-vascularization(r=0.802, P<0.001)and a moderate diagnostic consistency(r=0.539, P<0.001). Taking the enhancement level of 2 as the standard, CEUS showed a sensitivity of 75.8% and specificity of 67.4% for detecting the symptomatic plaque, and SMI showed a sensitivity of 58.6% and specificity of 69.5%.The two methods had similar specificity, and CEUS had a higher sensitivity than did SMI.@*Conclusions@#SMI and CEUS have a good consistency for detecting plaque surface morphology.SMI and CEUS are more correlated with plaque-induced symptoms than is two-dimensional ultrasound.The SMI has a higher display rate and repeatability than does CEUS for detecting the small fissures and the surface features of plaques.Compared with SMI-detected neo-vascularization, the degree of CEUS enhancement is more correlated with the symptoms.The specificity of CEUS and SMI is similar, and the sensitivity of CEUS is higher than that of SMI.
ABSTRACT
Objective To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI) and contrast-enhanced ultrasound(CEUS),and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard.Methods A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited,including 61 males and 31 females,aged(63.5 ± 7.7) years(range,4 2-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms,patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque (including surface morphology and neo-vascularization) were recorded.The ultrasonographic findings were chi-squarely tested.Results There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(x2 =6.865,P =0.032;x2 =22.494,P ＜ 0.001).The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups (x2 =10.367,P =0.006;x2 =8.186,P =0.041).The correlations of plaque surface morphology(r =0.856,P ＜ 0.001)and diagnostic consistency(r=0.802,P＜0.001)between SMI and CEUS were higher.In the symptom group,SMI-showed plaque fissures and small surface pitting were in 33.9 ％ (20/59) of patients,and CEUS-showed plaque fissures and small surface pitting were in 25.4％ (15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard,CEUS showed a sensitivity of 42.4％ and specificity of 80.4％ for detecting symptomatic plaques,and SMI showed a sensitivity of 54.2 ％ and specificity of 76.1％.The two methods had similar specificity,and SMIhad a slightly higher sensitivity than did CEUS.CEUS and SMI had a good correlation of plaque neo-vascularization(r =0.802,P ＜ 0.001)and a moderate diagnostic consistency(r=0.539,P ＜0.001).Taking the enhancement level of 2 as the standard,CEUS showed a sensitivity of 75.8 ％ and specificity of 67.4 ％ for detecting the symptomatic plaque,and SMI showed a sensitivity of 58.6％ and specificity of 69.5％.The two methods had similar specificity,and CEUS had a higher sensitivity than did SMI.Conclusions SMI and CEUS have a good consistency for detecting plaque surface morphology.SMI and CEUS are more correlated with plaque-induced symptoms than is two-dimensional ultrasound.The SMI has a higher display rate and repeatability than does CEUS for detecting the small fissures and the surface features of plaques.Compared with SMI-detected neo-vascularization,the degree of CEUS enhancement is more correlated with the symptoms.The specificity of CEUS and SMI is similar,and the sensitivity of CEUS is higher than that of SMI.
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Objective To observe the feasibility in neurosurgical brain tumor resection using ultrasound fusion navigation technology . Methods Thirty patients undergoing brain tumor rescetion accepted fusion ultrasound ( US ) navigation with magnetic renounce/computed tomography ( MR/CT ) technique and cognitive fusion" by neurosurgeon based on the tumor′s localization of magnetic renounce imaging (MRI) separately to definite the position and size of the craniotomy window flaps . After removal cranial bone ,conventional B-mode ultrasound scanning was used to detect lesion firstly . Then ,fusion US/MR navigation was applied again after automatically registration;the images of tumors from B-mode ultrasound and contrast-enhanced ultrasound separately were compared to those from coplanar reconstructive MR/CT in a real time . Results Fusion US/MR navigation was useful to define the position and size of the craniotomy window flaps ,and tumors in all patients were fully exposed to the microscope field of view . In all of 30 cases ,26 cases of fusion imaging of volume navigation technology were successfully registrated . The tumors in 3 cases of glioma ( WHO Ⅰ - Ⅱ grade) and 1 patient with pathologically verified inflammatory couldn′t be localized by conventional B-mode ultrasound but could be accurately localized after fusion ( US/MR) imaging navigation . Compared to contrast-enhanced MR ,high-grade glioma with contrast-enhanced ultrasound (CEUS) showed enhancement in arterial phase and clear tumor boundary rapidly . The enhanced modality with CEUS and MR was functioned equal . Low-grade glioma with CEUS showed scattered point or linear enhancement in arterial phase and the tumor′s margin was blurred . The preoperative T1-weighted enhanced MRI demonstrated no enhancement in the low-grade glioma . Conclusions Fusion ultrasound navigation can be used to definite size of bone flap before craniotomy . It is more suitable for fusion with preoperative T 2 Flair phase to localize low grade glioma . High-grade glioma is suitable to preoperative T 1 weighted enhanced phase for discerning margin of tumor .
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Objective To investigate the correlation between intraoperative ultrasonographic features and expression of immunohistochemical markers in patients with glioma.Methods Totally 116 patients with glioma confirmed pathologically were collected.Ultrasonic features were observed,including the main site of the tumor,maximum diameter,border,cystic degeneration,calcification,the degree of peritumoral edema and CDFI blood flow classification,and the correlation between ultrasonographic features and immunohistochemical results such as Ki-67 and isocitrate dehydrogenase 1 (IDH1) was analyzed.Results Univariate analysis showed that the border,peritumoral edema and CDFI blood flow were significantly different between negative and positive Ki-67 expression patients (P＜ 0.01).The border,cystic degeneration and peritumoral edema were distinct between negative and positive IDH1 patients (P＜0.01).Multivariate analysis showed that gliomas with clear border,high degree of peritumoral edema and rich CDFI blood flow tended to show positive Ki-67 expression,while those with vague border,low degree of peritumoral edema were frequently accompanied by positive IDH1 expression.Conclusion The border of gliomas,peritumoral edema and blood flow showed on ultrasonography may predict the expression of Ki-67 and IDH1.It is of great significance for preliminary evaluation on biological behaviors and prognosis of the tumors before surgical operation.